| NPI | 1649626938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 7967) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 7967) |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2016-05-05 |