| NPI | 1720428865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA065552) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110-004299) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2024-08-26 |