| NPI | 1114022050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 3214) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2019-09-11 |