| NPI | 1811152549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NH 0872) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MA AP2543) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2020-09-30 |