| NPI | 1336691914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 6750) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO 0004846) |
| Enumeration Date | 2016-10-28 |
| Last Update Date | 2024-11-19 |