| NPI | 1114340262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AK 153530) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AK 135364) |
| Enumeration Date | 2014-01-27 |
| Last Update Date | 2025-10-23 |