| NPI | 1942292396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WI 1283-023) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WI 1283-023) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2005-08-21 |
| Last Update Date | 2024-03-14 |