| NPI | 1508245911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C5-0012177) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9108643) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2024-10-16 |