| NPI | 1144555988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: OR PA150327) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: WA PA60121081) |
| Enumeration Date | 2009-10-13 |
| Last Update Date | 2010-07-27 |