| NPI | 1477073633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: GA 8371) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 8371) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2024-02-11 |