| NPI | 1982068938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AR PA-659) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AR PT2016-024) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2016-04-10 |