| NPI | 1841320561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 011626) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA22937) |
| 363AS0400X Physician Assistant, Surgical (Licence: CT 001288) | |
| 363AS0400X Physician Assistant, Surgical (Licence: CA PA22937) | |
| 363A00000X Physician Assistant (Licence: AZ 7881) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2026-06-18 |