| NPI | 1801247176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WI 4030) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085-005846) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2022-09-01 |