| NPI | 1720312077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 4495) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10001389B) |
| Enumeration Date | 2009-09-18 |
| Last Update Date | 2013-06-21 |