| NPI | 1346682796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA058048) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MD C05120) |
| Enumeration Date | 2013-07-26 |
| Last Update Date | 2021-05-26 |