| NPI | 1497510358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TN 5945) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 5945) |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2025-04-02 |