| NPI | 1538494091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA 672) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: FL PA9101219) |
| Enumeration Date | 2009-10-16 |
| Last Update Date | 2017-02-03 |