| NPI | 1487153078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9115276) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2018-02-08 |
| Last Update Date | 2023-08-11 |