| NPI | 1235308131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK 197990) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 4783) |
| 363A00000X Physician Assistant (Licence: CA 60056) | |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2023-11-15 |