| NPI | 1437300498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA057034) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 2680) |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2021-11-01 |