| NPI | 1528705258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: DC PA200001411) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110-008567) |
| Enumeration Date | 2022-05-15 |
| Last Update Date | 2022-05-15 |