| NPI | 1386668234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08101) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: RI PA00194) |
| 363A00000X Physician Assistant (Licence: SC 2160) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2024-08-15 |