| NPI | 1205596053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: FL PAT9115432) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: FL PENDING) |
| Enumeration Date | 2021-12-21 |
| Last Update Date | 2024-03-25 |