| NPI | 1285833590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DC PA84) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: DC 84) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2018-02-16 |