| NPI | 1033439849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA22260) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WV 01339) |
| Enumeration Date | 2010-06-03 |
| Last Update Date | 2013-07-31 |