| NPI | 1235544453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 7027) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DC PA031030) |
| 363A00000X Physician Assistant (Licence: MD C0005411) | |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 0110-004630) | |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2023-06-02 |