| NPI | 1033173059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AL PA.1522) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA A10569) |
| 363AS0400X Physician Assistant, Surgical (Licence: LA A10569) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2019-08-21 |