| NPI | 1265768691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NH 0955) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA PA3888) |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2013-09-24 |