| NPI | 1215962022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AK 493) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2012-01-27 |