| NPI | 1467423897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9107945) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AL PA-439) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2019-01-24 |