| NPI | 1710947874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ND PAC0206) |
| 363A00000X Physician Assistant (Licence: MT 97) | |
| 363AS0400X Physician Assistant, Surgical (Licence: WI 3112-23) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NM PA2020-0012) | |
| 363AS0400X Physician Assistant, Surgical | |
| 363AS0400X Physician Assistant, Surgical (Licence: MD C08711) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2023-06-20 |