| NPI | 1285885483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5770) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2011040196) |
| 363A00000X Physician Assistant (Licence: IL 085004141) | |
| Enumeration Date | 2008-10-06 |
| Last Update Date | 2015-11-14 |