| NPI | 1013988781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110840802) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: VA 0110840802) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2022-02-17 |