| NPI | 1356358089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA MA788) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MA 788) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2013-07-15 |