| NPI | 1922078757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR 481) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 18043) |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2014-04-25 |