| NPI | 1992193957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5929) |
| Additional Taxonomies | 242T00000X Perfusionist (Licence: OK 74) |
| Enumeration Date | 2014-12-29 |
| Last Update Date | 2024-03-11 |