| NPI | 1235289240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MO 06-179) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: IL 238000599) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2023-11-29 |