| NPI | 1922258102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 2343) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 9146) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2022-09-28 |