| NPI | 1073794012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C03809) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: DC PA030518) |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2014-11-26 |