| NPI | 1093749533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA17558) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: CA pa17558) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2024-01-17 |