| NPI | 1720050933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TN 1890) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IA 002193) |
| 363AS0400X Physician Assistant, Surgical (Licence: CA 55825) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2024-07-30 |