| NPI | 1215973060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA000444L) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 006298) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2020-07-29 |