| NPI | 1013223262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: SC 3517) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA054492) |
| Enumeration Date | 2010-08-26 |
| Last Update Date | 2021-03-16 |