| NPI | 1225083066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 004760) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 4760) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2020-08-18 |