| NPI | 1174845366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 005768) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 005768) |
| Enumeration Date | 2010-02-16 |
| Last Update Date | 2018-03-20 |