| NPI | 1649239385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA17742) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: ME pa873) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2022-01-03 |