| NPI | 1437127453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3486-23) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 1066) |
| 363A00000X Physician Assistant (Licence: GA 005899) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2015-04-02 |