| NPI | 1215983390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NH 0892) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA001755L) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2012-06-13 |