| NPI | 1962705038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NH 1586) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: OK APA1957) |
| Enumeration Date | 2010-12-13 |
| Last Update Date | 2020-04-30 |