| NPI | 1326098138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DC PA30110) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA PA30110) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2014-12-04 |