| NPI | 1245279959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA051266) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA000855) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2008-09-11 |