| NPI | 1720528367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9110227) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: KS 1503174) |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2026-03-25 |