| NPI | 1447233978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA 60840316) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 016932-1) |
| 363A00000X Physician Assistant (Licence: VA 0110-004447) | |
| 363AS0400X Physician Assistant, Surgical (Licence: OK 1013) | |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2023-08-29 |