| NPI | 1811184666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TX PA05951) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50-002626) |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2016-07-12 |