| NPI | 1851383236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 3209) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MT 165335) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2025-12-04 |