| NPI | 1205889326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA23284) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085-002096) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2021-11-03 |