| NPI | 1386978153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MS PA00131) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA 9105197) |
| Enumeration Date | 2009-09-28 |
| Last Update Date | 2016-12-23 |