| NPI | 1598997322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: HI AMD-377) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: DC 00022) |
| Enumeration Date | 2009-08-12 |
| Last Update Date | 2012-02-01 |