| NPI | 1598977456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA003427L) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA003427L) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2017-08-17 |