| NPI | 1497135230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9114956) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9114956) |
| Enumeration Date | 2015-06-07 |
| Last Update Date | 2023-11-29 |