| NPI | 1841613437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2048) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-04710) |
| Enumeration Date | 2014-02-02 |
| Last Update Date | 2014-04-06 |