| NPI | 1578568697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IN 10000519A) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: KY PA673) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2024-04-19 |