| NPI | 1740422716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60260928) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO 2986) |
| 363AS0400X Physician Assistant, Surgical (Licence: CT 002241) | |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2020-01-29 |