| NPI | 1932444205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C0006808) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 225100000X Physical Therapist (Licence: MA 19552) | |
| Enumeration Date | 2012-11-28 |
| Last Update Date | 2024-02-09 |