| NPI | 1023098944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C50000239) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2014-04-28 |