| NPI | 1841320421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2943) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-08284) |
| 363A00000X Physician Assistant (Licence: IL 085002934) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2018-08-30 |