| NPI | 1558476887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-04342) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA331) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2016-04-29 |