| NPI | 1467958827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA-2162) |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2022-01-07 |