| NPI | 1972978187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 3492) |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2022-11-18 |