| NPI | 1992878110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: CA PA53069) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MA 1660) |
| 363AS0400X Physician Assistant, Surgical (Licence: MA 1660) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2018-09-13 |