| NPI | 1518310333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 55591) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 3746) |
| 363AS0400X Physician Assistant, Surgical (Licence: CT 3746) | |
| Enumeration Date | 2016-07-16 |
| Last Update Date | 2024-06-21 |