| NPI | 1154604452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CO 0004374) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: ME PA001288) |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2015-10-05 |