| NPI | 1730546326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 7884) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 6922) |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2016-02-15 |