| NPI | 1598121170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA62570) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OH 50.006398RX) |
| 363AS0400X Physician Assistant, Surgical (Licence: CT 3507) | |
| Enumeration Date | 2016-01-12 |
| Last Update Date | 2023-11-08 |