| NPI | 1255403861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60698165) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA19289) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2021-06-17 |