| NPI | 1548293558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NH EL11614) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA 9102866) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2023-04-27 |