| NPI | 1831310879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5304) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D3023) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2013-02-27 |