| NPI | 1306200423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH 1268) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NH 1268) |
| 363A00000X Physician Assistant (Licence: MA PA5793) | |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2022-07-21 |