| NPI | 1689783722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 2136) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO 2272) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2016-02-15 |