| NPI | 1871154179 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NH 1503) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 1503) |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2019-08-07 |