| NPI | 1376888735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA22731) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA22731) |
| Enumeration Date | 2012-12-11 |
| Last Update Date | 2012-12-11 |