| NPI | 1588627376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AL PA-469) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9102616) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2014-12-03 |