| NPI | 1255338166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1084/001528) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 1084/001528) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2015-05-13 |