| NPI | 1598954976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA00732) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR PA00732) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2015-08-20 |