| NPI | 1730337858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 55215) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: AZ 10807) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2024-12-09 |