| NPI | 1871917518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other Surgical Technologist |
| Enumeration Date | 2014-02-18 |
| Last Update Date | 2015-05-06 |