| NPI | 1992248744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IA 089244) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 860285905) |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2021-03-04 |