| NPI | 1255490264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60801172) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA17801) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2018-10-08 |