| NPI | 1750352415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C02282) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD C0002282) |
| 363A00000X Physician Assistant (Licence: MD C02282) | |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2007-11-05 |