| NPI | 1891703633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: GA 005595) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IN 10000117A) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2019-01-03 |