| NPI | 1982899274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA205403) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA 19264) |
| 363AS0400X Physician Assistant, Surgical (Licence: WA PA10005239) | |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2022-09-27 |