| NPI | 1659472538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA052715) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA19863) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2021-06-18 |