| NPI | 1942583703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MT 29994) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: MI 5601006160) |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2015-11-30 |