| NPI | 1518924802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 3781) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 009418) |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2019-05-21 |