| NPI | 1285633263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AL PA.301) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA-301) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2023-04-11 |