| NPI | 1497837447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ID PA748) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NV PA706) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2016-06-24 |