| NPI | 1336337906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C03609) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MD C03609) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2010-09-20 |