| NPI | 1285056770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9107780) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL PA9107780) |
| 363A00000X Physician Assistant (Licence: FL PA9107780) | |
| Enumeration Date | 2014-01-17 |
| Last Update Date | 2023-11-28 |