| NPI | 1588222830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601009435APP19) |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: MI 5601009435APP19) |
| Enumeration Date | 2019-06-02 |
| Last Update Date | 2019-06-02 |