| NPI | 1841476231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WV 1232) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: WV 01232) |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2018-02-12 |