| NPI | 1992093066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IA 002215) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IA 002215) |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2021-08-17 |