| NPI | 1578600466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: HI AMD 307) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NV PA771) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2013-09-04 |