| NPI | 1841642667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 084075) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SD 1377) |
| 363AS0400X Physician Assistant, Surgical (Licence: IA 084075) | |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2023-07-07 |