| NPI | 1558412825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 283X00000X Rehabilitation Hospital (Licence: FL AL1745) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2021-10-29 |