| NPI | 1275048696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9110661) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: FL PA9110661) |
| Enumeration Date | 2017-12-07 |
| Last Update Date | 2018-02-06 |