| NPI | 1891900346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA 15993) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60693871) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2020-02-17 |