| NPI | 1801452495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3807) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TN 3807) |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2024-03-19 |