| NPI | 1891813804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX SA00237) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2015-11-16 |