| NPI | 1982651352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MO 2005004531) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: KS 15-02092) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2025-02-03 |