| NPI | 1215577366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA7538) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 6329) |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2023-11-02 |