| NPI | 1992477137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 2086S0129X (Licence: MD C0008184) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2022-09-26 |