| NPI | 1881933364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-08469) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 016379) |
| Enumeration Date | 2013-02-04 |
| Last Update Date | 2018-12-07 |