| NPI | 1922065556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3044) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA003013L) |
| 363A00000X Physician Assistant (Licence: SC 1530) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2016-08-03 |