| NPI | 1508842725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MD c0007564) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA53332) |
| 363A00000X Physician Assistant (Licence: NC 102528) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NC 102528) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CA PA53332) | |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2022-10-14 |