| NPI | 1023487006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CA 52824) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: CA 52824) |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2015-09-21 |