| NPI | 1609006527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006995) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0011868) |
| 363AS0400X Physician Assistant, Surgical | |
| 363A00000X Physician Assistant (Licence: CA PA-2063) | |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2024-08-29 |