| NPI | 1427568229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2838) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC MPA.2838TL) |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2017-11-06 |