| NPI | 1942504295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MD C04486) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2010-12-30 |
| Last Update Date | 2017-02-06 |