| NPI | 1548250954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OH 50-00-2337) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60150118) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2015-04-16 |