| NPI | 1942233846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0003441) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 1214) |
| 363A00000X Physician Assistant (Licence: GA 4470) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2007-07-08 |