| NPI | 1508047838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0001905) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 23 013684) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2019-07-31 |