| NPI | 1447971734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9116306) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL 9116306) |
| Enumeration Date | 2022-09-06 |
| Last Update Date | 2024-11-14 |