| NPI | 1982650966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MD C0003009) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: MD C03009) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2019-09-04 |