| NPI | 1356658868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL 729) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AL TA.1713) |
| Enumeration Date | 2010-09-03 |
| Last Update Date | 2024-03-14 |