| NPI | 1295410876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 11756) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-06-20 |
| Last Update Date | 2023-07-10 |