| NPI | 1497906606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-05332) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 1345) |
| 363A00000X Physician Assistant (Licence: VA 0110008323) | |
| 363A00000X Physician Assistant (Licence: FL PA9111448) | |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2024-05-13 |