| NPI | 1447495460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 4213) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 074936) |
| Enumeration Date | 2008-12-04 |
| Last Update Date | 2020-11-16 |