| NPI | 1235192774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 5357) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA2576) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2020-06-29 |