| NPI | 1437401502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AK PADA1214) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60314316) |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2023-08-22 |