| NPI | 1548214695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA052298) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA052298) |
| 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00160000) | |
| 363AS0400X Physician Assistant, Surgical (Licence: DE C50000449) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2018-08-30 |