| NPI | 1669098174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0007820) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601010032) |
| Enumeration Date | 2020-06-20 |
| Last Update Date | 2023-05-03 |