| NPI | 1316043094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-15947) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SC 1157) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2026-05-04 |