| NPI | 1720177884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: CA PA22733) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA22733) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2022-11-28 |