| NPI | 1376590059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA.189) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AL PA-189) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2024-05-23 |