| NPI | 1093054033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 2291) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: TN PA2291) |
| Enumeration Date | 2013-02-12 |
| Last Update Date | 2016-04-18 |