| NPI | 1780846428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10001498A) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: OH 50-003027) |
| 363AS0400X Physician Assistant Surgical | |
| 363AS0400X Physician Assistant Surgical (Licence: IN 10001498A) | |
| 363AS0400X Physician Assistant Surgical (Licence: TN 1601) | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2024-05-07 |