| NPI | 1811108491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9104178) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110001833) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2016-06-29 |