| NPI | 1033628235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA062595) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| 363AM0700X Physician Assistant, Medical (Licence: DE C5-0001183) | |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2021-09-09 |