| NPI | 1306914288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9101189) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SC 4685) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2024-11-04 |