| NPI | 1881895530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA19185) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA19185) |
| 363A00000X Physician Assistant (Licence: NC 0010-09050) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2026-07-13 |