| NPI | 1154926715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10276) |
| Additional Taxonomies | 204F00000X Transplant Surgery (Licence: GA 10276) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2020-12-02 |
| Last Update Date | 2024-10-15 |