| NPI | 1144285305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005872) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: 1070743) |
| 363AS0400X Physician Assistant Surgical (Licence: DC 031346) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2024-03-13 |