| NPI | 1154446631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9105420) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA 1061) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2012-09-07 |