| NPI | 1255379079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL OS13802) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA OT013129) |
| 208600000X Surgery (Licence: MA 257973) | |
| 2086S0102X Surgery, Surgical Critical Care (Licence: FL OS13802) | |
| 363A00000X Physician Assistant (Licence: PA ma051179) | |
| 363A00000X Physician Assistant (Licence: MD cooo2694) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2022-02-10 |