| NPI | 1831287614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0000743) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA CA14918) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2012-10-18 |