| NPI | 1669556213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: ID PA-827) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: MT 447) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2009-12-30 |