| NPI | 1437479219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 005857) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA student) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2016-07-25 |