| NPI | 1376578583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 004177) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9103779) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2013-12-23 |