| NPI | 1043683311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: FL PA9109111) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: GA 10558) |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2023-11-27 |