| NPI | 1962173773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 5592) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: WI 5592-23) |
| Enumeration Date | 2021-09-22 |
| Last Update Date | 2021-11-11 |