| NPI | 1942421110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9116539) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA003414L) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2023-05-18 |