| NPI | 1831487040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: DE C5-0000773) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: DE C5-0000773) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2024-09-13 |