| NPI | 1558332650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 1838) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA53072) |
| 363AS0400X Physician Assistant Surgical (Licence: CA PA53072) | |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2025-06-19 |