| NPI | 1831088616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PR 2619-P.A.) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PR 2619-P.A.) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL 21-225) | |
| Enumeration Date | 2025-06-28 |
| Last Update Date | 2025-06-30 |