| NPI | 1093042673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: DC PA030723) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C04106) |
| Enumeration Date | 2009-11-03 |
| Last Update Date | 2021-06-02 |