| NPI | 1659537652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110002887) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110002887) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2008-07-30 |
| Last Update Date | 2021-12-06 |