| NPI | 1497925135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA179815) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 002083) |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 0110002857) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CO 3418) | |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2021-04-30 |