| NPI | 1851470876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 3039) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA17167) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2008-08-04 |