| NPI | 1730431347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 006692) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: AL TA.1747) |
| 363AM0700X Physician Assistant, Medical (Licence: AL PA-865) | |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2024-04-08 |