| NPI | 1508843038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MA 1073) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MA 1073) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2023-08-17 |