| NPI | 1669479531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE c50000194) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: DE C50000194) |
| Enumeration Date | 2005-07-06 |
| Last Update Date | 2019-01-07 |