| NPI | 1730230814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 4895) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AK 367) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2015-05-04 |