| NPI | 1467548339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA14951) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 10159) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2021-11-02 |