| NPI | 1710767025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 5048) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 5048) |
| Enumeration Date | 2023-10-03 |
| Last Update Date | 2025-01-30 |