| NPI | 1336334135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 001955) |
| 363AS0400X Physician Assistant Surgical (Licence: UT 6914415-1206) | |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2015-04-14 |