| NPI | 1942248398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 1017994) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0001-01794) |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2010-01-22 |