| NPI | 1619940921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 005845) |
| Additional Taxonomies | 225500000X Specialist/Technologist |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2018-12-28 |