| NPI | 1487045936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NV PA1824) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OK 2439) |
| Enumeration Date | 2015-02-05 |
| Last Update Date | 2019-11-13 |