| NPI | 1922830728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9119504) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2025-08-18 |