| NPI | 1841514031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC PA1498) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SC PA1498) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA9106500) | |
| Enumeration Date | 2010-03-17 |
| Last Update Date | 2020-12-17 |