| NPI | 1417181959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NH 0743) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA pa20304) |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2009-11-06 |