| NPI | 1437669512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C0006824) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110005953) |
| 363A00000X Physician Assistant (Licence: MD C0006824) | |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 0110005953) | |
| Enumeration Date | 2017-10-03 |
| Last Update Date | 2018-09-25 |