| NPI | 1396787917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-00728) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA052325) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2014-05-21 |