| NPI | 1265711550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-523) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AK 2143) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2013-07-23 |