| NPI | 1205819851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SC 1406) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 1406) |
| 363AS0400X Physician Assistant, Surgical (Licence: NC 103134) | |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2024-05-24 |