| NPI | 1619452885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA060190) |
| Additional Taxonomies | 2086X0206X Surgery, Surgical Oncology (Licence: PA MA060190) |
| Enumeration Date | 2018-10-03 |
| Last Update Date | 2018-11-13 |