| NPI | 1033284377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-05020) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 011194) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2023-07-14 |