| NPI | 1164469979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 4344) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 004344) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2025-08-07 |