| NPI | 1457735870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: DE C5-0001387) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA ma001551l) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2020-03-26 |