| NPI | 1992278584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA63106) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 022810) |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2025-08-06 |