| NPI | 1487772901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: TX SA00309) |
| 246ZS0410X Specialist/Technologist, Other Surgical Technologist (Licence: TX 03-117) | |
| 246ZS0410X Specialist/Technologist, Other Surgical Technologist (Licence: TX SA00309) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2021-12-03 |