| NPI | 1801135264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.0007516) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 016381) |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2022-10-24 |