| NPI | 1033384011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: HI AMD536) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA15136) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2019-10-30 |