| NPI | 1841668910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA8312) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: RI PA00836) |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2024-06-06 |