| NPI | 1417927443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 0613) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 10047) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2007-07-08 |