| NPI | 1568868610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SD 1109) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IA 088814) |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2022-07-21 |