| NPI | 1881790095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: UT pa0317) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NV 682) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2024-03-13 |