| NPI | 1508881822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MS PA039) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA3654) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2008-10-24 |