| NPI | 1548500440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 002876) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 002876) |
| Enumeration Date | 2013-03-01 |
| Last Update Date | 2013-11-13 |