| NPI | 1447299789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MI 5601007215) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9108308) |
| 363AS0400X Physician Assistant, Surgical (Licence: OH 50-00-0236) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2020-03-30 |