| NPI | 1952085953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CT 6934) |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2025-02-14 |