| NPI | 1477874725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA-054364) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA054364) |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2013-12-17 |