| NPI | 1225346778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NE 2011) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO 0003503) |
| Enumeration Date | 2010-09-17 |
| Last Update Date | 2024-11-13 |