| NPI | 1740448182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NC 102199) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 1032066) |
| Enumeration Date | 2008-05-31 |
| Last Update Date | 2021-03-09 |