| NPI | 1306336995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: 1149671) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 0010-11478) |
| 208800000X Urology (Licence: NC 0010-11478) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-11478) | |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2022-02-21 |