| NPI | 1730825829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: AR PA-1081) |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2022-05-12 |