| NPI | 1386842375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9104220) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PAT9104220) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2014-07-23 |