| NPI | 1851599476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PA MA064638) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 1573) |
| 363AS0400X Physician Assistant, Surgical (Licence: GA 5094) | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2024-11-08 |