| NPI | 1760506869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA51543) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110001200) |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 0110001200) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2014-07-22 |