| NPI | 1598139388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MN 13022) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0004490) |
| Enumeration Date | 2015-11-17 |
| Last Update Date | 2019-06-05 |