| NPI | 1518994722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-09862) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2020-11-19 |