| NPI | 1265045017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA64997) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 8169) |
| Enumeration Date | 2020-08-30 |
| Last Update Date | 2025-05-13 |