| NPI | 1992750038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL 0001631) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: GA 3931) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2014-01-28 |