| NPI | 1689701815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA052910) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA052910) |
| 363A00000X Physician Assistant (Licence: PA MA052910) | |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2024-05-07 |