| NPI | 1811184369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 54584) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA10005287) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2023-01-24 |