| NPI | 1467471045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MS PA00070) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MS PA00070) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2019-04-16 |