| NPI | 1518977826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-397) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA397) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2014-04-23 |