| NPI | 1386927309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: WV 01574) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2013-04-03 |