| NPI | 1083733281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: DE C5-0000518) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA002905L) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2007-07-08 |