| NPI | 1114741980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL 24-363) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PR 2862) |
| 363A00000X Physician Assistant (Licence: PR 2862) | |
| Enumeration Date | 2024-11-08 |
| Last Update Date | 2025-12-16 |