| NPI | 1922465509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: 1922465509) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2023-11-30 |