| NPI | 1942260302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0009061) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: GA 005050) |
| 363AS0400X Physician Assistant, Surgical (Licence: FL PA3218) | |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2026-09-30 |