| NPI | 1811969975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: SC 543) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC A543) |
| 363A00000X Physician Assistant (Licence: SC 543) | |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2024-06-03 |