| NPI | 1952705246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0005499) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA003391) |
| Enumeration Date | 2014-10-15 |
| Last Update Date | 2015-04-06 |