| NPI | 1942221692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 4847) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AK 621) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2017-02-03 |