| NPI | 1558538355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: 005306) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 005306) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2021-09-28 |