| NPI | 1477894459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: VA 4093) | |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: VA 4093) | |
| Enumeration Date | 2013-03-15 |
| Last Update Date | 2022-06-28 |