| NPI | 1295704195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: VA 0101039268) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101039268) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2007-12-06 |