| NPI | 1083795132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 004505) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NC 1000755) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2018-03-17 |