| NPI | 1083268676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: RI PA01672) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA61000082) |
| Enumeration Date | 2019-07-31 |
| Last Update Date | 2024-04-22 |