| NPI | 1184906695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA21747) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA61013600) |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2024-04-17 |