| NPI | 1356457360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AK 1063) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 96) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2013-07-08 |