| NPI | 1407991490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 23050) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MO 2024042526) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2024-11-22 |