| NPI | 1952337636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: FL PA9101378) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA65079) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2026-04-10 |