| NPI | 1952557449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 2737) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9104689) |
| Enumeration Date | 2008-08-15 |
| Last Update Date | 2020-06-04 |