| NPI | 1023326923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OR PA185732) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA21142) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2018-05-15 |