| NPI | 1457379117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MO 2022016230) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA13981) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2022-06-06 |