| NPI | 1295929032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1527) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA 001840) |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2019-06-06 |