| NPI | 1568778918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ID PA-1166) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OR PA152966) |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2022-07-21 |