| NPI | 1376739243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TN 1557) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2014-05-28 |