| NPI | 1821635467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 58356) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant | |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2020-07-29 |