| NPI | 1477894459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC PA4870) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: VA 4093) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist | |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: VA 4093) | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2013-03-15 |
| Last Update Date | 2025-02-25 |