| NPI | 1093224347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PR 000263-P.A) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL 17-460) |
| Enumeration Date | 2017-09-28 |
| Last Update Date | 2022-07-21 |