| NPI | 1770953606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 2856) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TN 2856) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2024-10-27 |