| NPI | 1235430315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 2127) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 6003) |
| Enumeration Date | 2010-11-05 |
| Last Update Date | 2010-12-06 |