| NPI | 1427377027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA002432L) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA OA002527) |
| Enumeration Date | 2010-05-21 |
| Last Update Date | 2016-01-08 |