| NPI | 1881979003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO 3320) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2012-08-22 |