| NPI | 1366968398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL 1277) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL 1856) |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2017-12-15 |