| NPI | 1013981562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA10004953) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: ID PA-608) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2024-04-12 |