NPI | 1932589611 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CT 3353) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2015-06-08 |
Last Update Date | 2025-09-25 |