| NPI | 1508240797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601010368) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: VA 0110-005037) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2023-01-03 |