| NPI | 1598934747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 002134) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA 19617) |
| Enumeration Date | 2008-02-21 |
| Last Update Date | 2008-12-15 |