| NPI | 1033894910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MI 5601011785) |
| Additional Taxonomies | 2086S0127X Surgery Trauma Surgery (Licence: MI 5601011785) |
| Enumeration Date | 2023-06-19 |
| Last Update Date | 2024-03-29 |