| NPI | 1265106967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 10504) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 10504) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2021-08-05 |
| Last Update Date | 2024-04-26 |