| NPI | 1821338344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NH NH0933) |
| Enumeration Date | 2013-02-20 |
| Last Update Date | 2024-10-21 |