| NPI | 1235258971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0003412) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA030474) |
| 363A00000X Physician Assistant (Licence: WI 1718-023) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2007-07-08 |