| NPI | 1558982587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA64137) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA205581) |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2026-07-14 |