| NPI | 1336217082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0002004) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0000686) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2010-05-05 |