| NPI | 1437774858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 7079) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA PA7584) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2025-07-06 |