| NPI | 1417130295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA51477) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IL 085003166) |
| Enumeration Date | 2007-12-14 |
| Last Update Date | 2023-08-02 |