| NPI | 1245206424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 01374) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: IA 01374) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2022-10-21 |