| NPI | 1730711151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 12988) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9113011) |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2025-07-30 |