| NPI | 1033208889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MS PA00150) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: IA 001820) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2015-10-05 |