| NPI | 1487779591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA000512L) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: DE C5-0000404) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2010-10-01 |