| NPI | 1225263353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TN 174) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 4594) |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2017-11-16 |