| NPI | 1689625964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AK PADA631) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 004580) |
| 363AS0400X Physician Assistant, Surgical (Licence: MI 004580) | |
| 363AS0400X Physician Assistant, Surgical (Licence: IN 10001088A) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2019-10-04 |