| NPI | 1457861387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AL PA.2378) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C07307) |
| 363AS0400X Physician Assistant, Surgical (Licence: OR PA201518) | |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2024-06-06 |