| NPI | 1326375254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA054119) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA002393) |
| Enumeration Date | 2009-11-13 |
| Last Update Date | 2009-11-13 |