| NPI | 1821096686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: LA PA.A10284) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: LA A10284) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2025-11-24 |