| NPI | 1538250246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MT MED-PAC-LIC-42349) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA187906) |
| 363AS0400X Physician Assistant, Surgical (Licence: ND PAC0184) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2021-10-25 |