| NPI | 1427714567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110008936) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MD C0008336) |
| 363AS0400X Physician Assistant, Surgical (Licence: DC PA200001373) | |
| Enumeration Date | 2021-11-12 |
| Last Update Date | 2024-01-29 |