| NPI | 1144469552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: GA 005529) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: GA 005529) |
| Enumeration Date | 2009-02-09 |
| Last Update Date | 2019-05-15 |