| NPI | 1003006115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 5084) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 005084) |
| 363AS0400X Physician Assistant, Surgical (Licence: AL PA.749) | |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2025-08-06 |