| NPI | 1346297629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 787) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 003880) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2022-12-08 |