| NPI | 1235293804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: OK 5062) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: AL PA-508) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2023-08-21 |