| NPI | 1437634680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 3714) |
| Enumeration Date | 2018-10-03 |
| Last Update Date | 2023-11-20 |