| NPI | 1467471060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 103871) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 0003871) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2013-04-22 |