| NPI | 1366703845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SC 1797) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SC TL1797) |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2020-12-14 |