| NPI | 1710334248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: ID PA-2266) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: ID PA-1517) |
| 363AS0400X Physician Assistant, Surgical (Licence: WA PA60794259) | |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2022-06-30 |