| NPI | 1598302069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA8045) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA PA8045) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 363AS0400X Physician Assistant, Surgical (Licence: CT 7610) | |
| Enumeration Date | 2019-12-04 |
| Last Update Date | 2026-03-13 |