| NPI | 1841590841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA4080) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 002799) |
| Enumeration Date | 2010-10-25 |
| Last Update Date | 2024-06-06 |