| NPI | 1003355256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA.1229) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AL 1229) |
| Enumeration Date | 2017-02-21 |
| Last Update Date | 2023-04-24 |