| NPI | 1821426792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: DC PA031010) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2013-10-31 |
| Last Update Date | 2023-06-23 |