| NPI | 1285082552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CT 23.003624) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 23.003624) |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2025-03-19 |