| NPI | 1568616027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 21491) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 4287) |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2022-04-25 |