| NPI | 1437435112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: PA MA055271) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA055271) |
| 363A00000X Physician Assistant (Licence: PA OA002759) | |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2020-04-21 |