| NPI | 1588972749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: FL PA9119071) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085003850) |
| 363AS0400X Physician Assistant Surgical (Licence: IN 10002389A) | |
| Enumeration Date | 2010-09-21 |
| Last Update Date | 2024-08-09 |