| NPI | 1265519946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NH 0531) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MA 1884) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2015-06-04 |