| NPI | 1275840357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PR 001333) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: IL 238.000099) |
| 363A00000X Physician Assistant (Licence: PR 1333) | |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2022-11-01 |