| NPI | 1437463247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 5847) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL Pending) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2022-10-26 |