| NPI | 1285963678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA20496) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: CA PA20496) |
| Enumeration Date | 2009-12-14 |
| Last Update Date | 2011-04-20 |