| NPI | 1447337118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CA 53032) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 53032) |
| 363AS0400X Physician Assistant Surgical (Licence: TX PA04763) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2024-09-26 |