| NPI | 1558509117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA3733) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MA PA3733) |
| Enumeration Date | 2009-02-04 |
| Last Update Date | 2023-02-13 |