| NPI | 1487806006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IN 1000105A) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL PA9104831) |
| Enumeration Date | 2008-10-14 |
| Last Update Date | 2009-11-23 |