| NPI | 1497006183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-03788) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-03788) |
| 363AM0700X Physician Assistant, Medical (Licence: NC 186191) | |
| Enumeration Date | 2012-09-21 |
| Last Update Date | 2024-04-26 |