| NPI | 1417321894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9109130) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9109130) |
| Enumeration Date | 2015-11-22 |
| Last Update Date | 2023-07-14 |