| NPI | 1083427397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: VA 0136000746) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: DC SA2000005) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2025-01-30 |
| Last Update Date | 2025-10-03 |