| NPI | 1851764856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OK 4677) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AR P-T1548) |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2023-01-26 |