| NPI | 1033153572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA15202) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC9256) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2023-12-20 |