| NPI | 1982338190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: SC 4459) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC 4459) |
| Enumeration Date | 2022-07-13 |
| Last Update Date | 2025-09-15 |