| NPI | 1043325178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 4647) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MT 41546) |
| 363AS0400X Physician Assistant, Surgical (Licence: IL 085-002727) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2024-01-29 |