| NPI | 1164006615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 10252) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 1181566) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2024-05-07 |