| NPI | 1851402549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MT 399) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA2582) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-11-27 |