| NPI | 1295163699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: AZ 7433) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA23239) |
| Enumeration Date | 2013-10-22 |
| Last Update Date | 2024-03-26 |