| NPI | 1699737361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9103129) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA-16318) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2015-02-22 |