| NPI | 1366827891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NH 1116) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA PA5357) |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2015-09-10 |