| NPI | 1508018375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 4288) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: AZ 4288) |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2020-09-03 |