| NPI | 1275517054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 1608) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 009362-1) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2008-12-31 |