| NPI | 1346577954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WI 3311) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MD 03-153) |
| Enumeration Date | 2009-11-03 |
| Last Update Date | 2015-09-23 |