| NPI | 1033444930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 007805) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA20597) |
| Enumeration Date | 2009-10-09 |
| Last Update Date | 2017-01-25 |