| NPI | 1205294394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MO 2016005466) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2016005466) |
| Enumeration Date | 2016-02-03 |
| Last Update Date | 2024-09-12 |