| NPI | 1316902216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA20910) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C0000407) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2010-10-14 |