| NPI | 1932396249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C06794) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA053875) |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2022-08-10 |