| NPI | 1932152972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 104062) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2021-02-18 |