| NPI | 1760412894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: LA PA.A10057) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AS0400X Physician Assistant, Surgical (Licence: PA.A10057) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2018-07-31 |