| NPI | 1902182348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TN 2069) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 2069) |
| 363A00000X Physician Assistant (Licence: VA 0110007464) | |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 0110007464) | |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2025-04-22 |