| NPI | 1053847863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3233) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: TN 3233) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2020-07-28 |