| NPI | 1548899313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA 58465) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2021-11-02 |