| NPI | 1538161278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 1864-23) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 1864-023) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2023-03-01 |