| NPI | 1841801685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PR 000754-PA) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL 21-517) |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2021-09-21 |