| NPI | 1548448210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA050808) |
| Additional Taxonomies | 367A00000X Advanced Practice Midwife (Licence: PA MA050808) |
| Enumeration Date | 2008-02-05 |
| Last Update Date | 2019-03-26 |