| NPI | 1023033552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA16667) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA PA16667) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2010-07-26 |