| NPI | 1710365705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA52478) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 52478) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2020-10-24 |