| NPI | 1114942554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA10004008) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA 52770) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2020-10-09 |