| NPI | 1437566395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA186549) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA 51550) |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2018-06-15 |