| NPI | 1457328478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-924) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 1293) |
| 363AS0400X Physician Assistant, Surgical (Licence: TN 1293) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2011-09-20 |