| NPI | 1124056767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA15662) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA15662) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2024-01-22 |