| NPI | 1609493964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9113326) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: FL PA9113326) |
| Enumeration Date | 2020-07-02 |
| Last Update Date | 2024-12-07 |