| NPI | 1326049461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 3234) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: GA 3234) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2026-07-08 |