| NPI | 1831381805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-7990) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9104281) |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2018-11-29 |