| NPI | 1235188301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA 200134) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: LA OTT.Z11857) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2019-06-13 |