| NPI | 1730527995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MA 8531) |
| 225200000X Physical Therapy Assistant (Licence: MD A3923) | |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2019-09-30 |