| NPI | 1891731188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL 363A00000X) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV 837) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2013-05-29 |