| NPI | 1740254598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NE 1919) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 7676) |
| 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0003410) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NV PA1260) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CA PA22399) | |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2024-01-17 |