| NPI | 1922269521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110002794) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 10725) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2024-11-22 |