| NPI | 1184660748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 2824) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA16759) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2021-10-08 |