| NPI | 1689759862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA052891) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: DE C5-0000717) |
| 363A00000X Physician Assistant (Licence: DE C50000717) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00161900) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2016-09-28 |