| NPI | 1336373257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-03428) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9104956) |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2012-08-10 |