| NPI | 1801213467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NH 3580) |
| Enumeration Date | 2014-03-20 |
| Last Update Date | 2026-01-05 |