| NPI | 1689043978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C05889) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R185193) |
| Enumeration Date | 2015-09-17 |
| Last Update Date | 2017-01-12 |