| NPI | 1881020162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: ME PA2338) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: WA PA60394758) |
| Enumeration Date | 2013-09-18 |
| Last Update Date | 2022-07-11 |