| NPI | 1447468590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NE 1437) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0003493) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2009-05-07 |