| NPI | 1225362551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: KS 15-01799) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 4480) |
| 363AM0700X Physician Assistant, Medical (Licence: RI PA00563) | |
| Enumeration Date | 2009-09-18 |
| Last Update Date | 2015-07-16 |