| NPI | 1356730865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 10354) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AL PA.1035) |
| Enumeration Date | 2015-01-21 |
| Last Update Date | 2022-09-09 |