| NPI | 1083829089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: OR 20064) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: OR 102653) |
| Enumeration Date | 2007-05-12 |
| Last Update Date | 2019-04-12 |