| NPI | 1851559967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 005349) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA 9104493) |
| Enumeration Date | 2008-05-26 |
| Last Update Date | 2019-02-27 |