| NPI | 1427463595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA056935) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA003319) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2019-03-26 |