| NPI | 1538463252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MT 646) |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2019-02-19 |