| NPI | 1013286335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA22006) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA07528) |
| 363A00000X Physician Assistant (Licence: OR PJ168476) | |
| Enumeration Date | 2011-12-14 |
| Last Update Date | 2014-07-18 |