| NPI | 1396258869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SC TL2878) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SC 2878) |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2024-04-18 |