| NPI | 1043453202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 20231) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA20231) |
| Enumeration Date | 2009-04-16 |
| Last Update Date | 2019-07-29 |