| NPI | 1336305796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 53479) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 009782) |
| 174400000X Specialist (Licence: DC PA030526) | |
| Enumeration Date | 2008-08-05 |
| Last Update Date | 2016-11-30 |