| NPI | 1669955613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: 16-381) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: NM 16-381) |
| Enumeration Date | 2018-09-14 |
| Last Update Date | 2018-11-28 |