| NPI | 1407592215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: CO SA.0002850) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: CO ST.0001857) | |
| Enumeration Date | 2022-05-05 |
| Last Update Date | 2023-05-14 |