| NPI | 1306123955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NH 0962) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: FL 9106307) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL 9106307) | |
| Enumeration Date | 2011-11-10 |
| Last Update Date | 2013-10-04 |