| NPI | 1184630774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CA PA20342) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA00344) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2018-05-08 |