| NPI | 1235319757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: LA PA.200156) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: LA PA200156) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2017-01-16 |