| NPI | 1831882968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TN 5652) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-06-02 |
| Last Update Date | 2023-12-20 |