| NPI | 1093953838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA20179) | |
| Enumeration Date | 2009-02-02 |
| Last Update Date | 2022-08-09 |