| NPI | 1972786879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TN 5078) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 5078) |
| 363A00000X Physician Assistant (Licence: CA PA19546) | |
| Enumeration Date | 2007-12-13 |
| Last Update Date | 2023-06-05 |