| NPI | 1821158882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL pa.858) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 003428) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2014-05-16 |