| NPI | 1801210026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA53511) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C05327) |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2016-09-22 |