| NPI | 1033219662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA22694) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| 363AS0400X Physician Assistant, Surgical | |
| 363AS0400X Physician Assistant, Surgical (Licence: MA PA2233) | |
| 363A00000X Physician Assistant (Licence: CA PA22694) | |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2014-07-01 |