| NPI | 1861494270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-647) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2021-05-26 |