| NPI | 1598132961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SC 3234) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SC TL3234) |
| 363AS0400X Physician Assistant, Surgical (Licence: NC 0010-05930) | |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2020-12-08 |