| NPI | 1962817825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA TMA052929) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2018-04-20 |