| NPI | 1053422444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 1040904) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA14730) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-03-07 |