| NPI | 1699731240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA-4) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AL PA-4) |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2010-02-26 |