| NPI | 1396788436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MA PA979) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C0002635) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2014-05-16 |