| NPI | 1083249320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TN 4175) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 4175) |
| 363A00000X Physician Assistant (Licence: MS PA00501) | |
| 363AS0400X Physician Assistant, Surgical (Licence: MS PA00501) | |
| Enumeration Date | 2020-03-06 |
| Last Update Date | 2021-02-24 |