| NPI | 1942483425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-02024) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC PA973) |
| Enumeration Date | 2007-12-07 |
| Last Update Date | 2009-10-17 |