| NPI | 1336283803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C0001161) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE CS-0000589) |
| 363A00000X Physician Assistant (Licence: MD C0001161) | |
| Enumeration Date | 2007-02-17 |
| Last Update Date | 2008-08-19 |