| NPI | 1235395088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IA 001943) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WI 2452) |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2021-01-28 |