| NPI | 1811436132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL 17142) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL 17142) |
| 363AS0400X Physician Assistant, Surgical (Licence: IA 17142) | |
| Enumeration Date | 2017-02-20 |
| Last Update Date | 2020-02-10 |