| NPI | 1437455318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-898) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AZ 4810) |
| Enumeration Date | 2011-02-10 |
| Last Update Date | 2013-01-21 |