| NPI | 1881658854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MA PA7375) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9102063) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2023-11-29 |