| NPI | 1952490013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SC 1325) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA 1582) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2015-10-20 |