| NPI | 1669752317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 6049) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2011-08-26 |
| Last Update Date | 2023-08-07 |