| NPI | 1003044785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 51684) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 1087705) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2014-09-03 |