| NPI | 1598741068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-801) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NV 514) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2009-09-02 |