| NPI | 1528499910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VT 055-0031496) |
| Enumeration Date | 2013-12-10 |
| Last Update Date | 2021-04-08 |