| NPI | 1467798454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA 9106936) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9106936) |
| Enumeration Date | 2012-12-18 |
| Last Update Date | 2016-05-02 |