| NPI | 1508920539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 004541) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA.311) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2021-08-31 |