| NPI | 1275591240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 000960) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 000960) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2007-07-08 |