| NPI | 1558686717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TN 3084) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: TN 3182) |
| Enumeration Date | 2010-03-31 |
| Last Update Date | 2016-09-26 |