| NPI | 1326195173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AL PA.763) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SC 5387) |
| 363AS0400X Physician Assistant, Surgical (Licence: MO 2023025752) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2024-09-17 |