| NPI | 1659372092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AL PA.352) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9105021) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9105021) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2019-03-05 |