| NPI | 1982675401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA051003) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: VA 0110005909) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2024-10-30 |