| NPI | 1780984021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0004997) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085003942) |
| Enumeration Date | 2010-11-02 |
| Last Update Date | 2026-04-01 |