| NPI | 1467785717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0004515) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: KY TC037) |
| Enumeration Date | 2009-09-17 |
| Last Update Date | 2021-06-08 |