| NPI | 1316925142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA003514L) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA000499L) |
| 363A00000X Physician Assistant (Licence: DE C50000327) | |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2009-12-23 |