| NPI | 1528388352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA051382) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA051382) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2015-11-10 |