| NPI | 1386099224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: LA 303108) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: LA 303108) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2025-05-16 |