| NPI | 1255770863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 6022) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: CA PA22993) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2024-02-14 |