| NPI | 1336177476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 001707) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2018-05-24 |