| NPI | 1467608968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA053525) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA TMA051966) |
| Enumeration Date | 2008-08-15 |
| Last Update Date | 2012-12-10 |