| NPI | 1669009478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 3536) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC MPA.3536) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2023-10-16 |