| NPI | 1427018522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: UT 4771398-1206) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OR PA01035) |
| 363AS0400X Physician Assistant, Surgical (Licence: HI AMD 353) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2023-04-14 |