| NPI | 1922035989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA18487) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA Interim License) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2019-02-20 |