| NPI | 1902132335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110 003103) |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2024-10-31 |