| NPI | 1932526332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA5214) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 001004780) |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2014-12-16 |