| NPI | 1588685069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: FL ME78025) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME78025) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2016-08-12 |