| NPI | 1053586305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA19721) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA 19721) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2011-08-24 |