| NPI | 1417924028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 4292) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SC PA1198) |
| 363AS0400X Physician Assistant, Surgical (Licence: TN PA0000001669) | |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9106353) | |
| 363AS0400X Physician Assistant, Surgical (Licence: ID PA-1765) | |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2022-06-03 |