| NPI | 1598309403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL 9112662) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9112662) |
| Enumeration Date | 2019-11-04 |
| Last Update Date | 2021-08-09 |