| NPI | 1891834131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 101878) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2020-09-22 |