| NPI | 1376632364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TN 1395) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 1395) |
| 363AS0400X Physician Assistant, Surgical (Licence: AR 1072420) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2024-12-03 |