| NPI | 1003412818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PR 2568-P.A.) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: WI 20-463) |
| 363AS0400X Physician Assistant, Surgical (Licence: PR 2568-P.A.) | |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2025-06-27 |