| NPI | 1932130374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA61005432) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 007601) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2020-12-15 |