| NPI | 1518023001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 100077) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC NC100077) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2018-04-23 |