| NPI | 1114558491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: PA MA062554) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: MD C0007743) |
| 363AS0400X Physician Assistant Surgical | |
| 363AS0400X Physician Assistant Surgical (Licence: PA MH6959160) | |
| Enumeration Date | 2020-01-27 |
| Last Update Date | 2024-10-10 |