| NPI | 1487644597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MT 211) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MT 622) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2023-11-27 |