| NPI | 1306014626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 10883) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA19587) |
| Enumeration Date | 2008-02-20 |
| Last Update Date | 2024-11-21 |