| NPI | 1013356757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 3489) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 23034) |
| Enumeration Date | 2013-06-16 |
| Last Update Date | 2018-09-14 |