| NPI | 1922763069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 4227) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2024-04-04 |