| NPI | 1841427937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WV 01518) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: VA 0110003033) |
| 363AS0400X Physician Assistant, Surgical (Licence: WV 513) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2014-05-08 |