| NPI | 1679731335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO 2544) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 2544) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2023-06-21 |