| NPI | 1295734150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CA PA19256) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: SC 2162) |
| 363AS0400X Physician Assistant Surgical (Licence: AZ 2773) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2018-09-13 |