| NPI | 1205164217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 005712) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: GA 005712) |
| Enumeration Date | 2009-12-02 |
| Last Update Date | 2024-01-18 |