| NPI | 1336333855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MD D70201) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD 961845) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2010-05-19 |