| NPI | 1609002385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-02093) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2020-12-08 |