| NPI | 1528231792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD C03581) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C3581) |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2021-08-03 |