| NPI | 1578532263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 2878) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 2878) |
| 363AS0400X Physician Assistant, Surgical (Licence: MO 2012002427) | |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2018-06-25 |