| NPI | 1558921841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 004513) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 00453) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2022-08-19 |