| NPI | 1144698978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SD 1037) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IA 130740) |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2025-02-12 |