| NPI | 1689751893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 5924) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 15395) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2015-09-22 |