| NPI | 1316057714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 2828) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA10005053) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2014-11-14 |