| NPI | 1467837716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA53882) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60605829) |
| 363AS0400X Physician Assistant, Surgical (Licence: WA PA60605829) | |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2022-09-21 |