| NPI | 1205022241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 3681) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: AZ 3681) |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2012-10-30 |