| NPI | 1477587525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-08623) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AR P-T0611) |
| 363AM0700X Physician Assistant, Medical (Licence: AR PA-287) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2019-01-30 |