| NPI | 1326406224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA 61032719) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 6763) |
| 363AS0400X Physician Assistant, Surgical (Licence: NH 1145) | |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2024-09-16 |