| NPI | 1730350323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AL PA-568) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AL PA568) |
| 363AS0400X Physician Assistant, Surgical (Licence: AL PA.568) | |
| Enumeration Date | 2008-03-21 |
| Last Update Date | 2023-02-02 |