| NPI | 1437419132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110002277) |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2022-06-03 |