| NPI | 1841373859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NV PA-C0176) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011220) |
| 363A00000X Physician Assistant (Licence: GA 004959) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2007-11-28 |