| NPI | 1841001757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA066436) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA007184) |
| 363AS0400X Physician Assistant, Surgical (Licence: PA OA007184) | |
| 363AS0400X Physician Assistant, Surgical (Licence: PA MA066436) | |
| Enumeration Date | 2025-01-20 |
| Last Update Date | 2025-02-14 |