| NPI | 1548409717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA053466) |
| Enumeration Date | 2009-02-11 |
| Last Update Date | 2022-02-10 |