| NPI | 1730651480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AL PA.1461) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AL 1874) |
| Enumeration Date | 2018-12-19 |
| Last Update Date | 2023-04-24 |