| NPI | 1326037110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 7882429-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 1041050) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2012-02-02 |