| NPI | 1194000281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA.893) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: UT 339259-8906) |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2015-02-25 |