| NPI | 1205877842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: GA 10064) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: UT 377832-1206) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2023-02-21 |