| NPI | 1275864399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA20812) |
| Enumeration Date | 2010-01-29 |
| Last Update Date | 2021-12-06 |