| NPI | 1619524535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PR 2112-P.A.) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL 19-208) |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2024-07-31 |