| NPI | 1437584448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CT 5544) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WA PA 60410146) |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2022-02-07 |