| NPI | 1679756688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NV PA1469) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 3772) |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2020-08-28 |