| NPI | 1578975082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 7179) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO PA0004275) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2024-04-26 |