| NPI | 1396877338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA002819L) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2025-06-27 |