| NPI | 1598965097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MT 19246) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MD C03516) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2016-02-03 |