| NPI | 1174789994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ID PA-1159) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OR PA156906) |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2023-08-30 |