| NPI | 1467653378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA063551) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OR PA154902) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2022-09-27 |