| NPI | 1245239417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MO 2003008015) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA53393) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2021-03-03 |