| NPI | 1013988955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA51630) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CO PA.008727) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2025-01-21 |