| NPI | 1245713031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 10616) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 10002599A) |
| Enumeration Date | 2018-09-08 |
| Last Update Date | 2024-12-11 |