| NPI | 1275784068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 2360) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PAT9104791) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PAT9104791) | |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2009-12-29 |