| NPI | 1487117594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 56355) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: CA 56355) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2021-12-01 |