| NPI | 1508951690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0004627) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0002451) |
| 363A00000X Physician Assistant (Licence: PA MA0532470) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2016-03-28 |