| NPI | 1083646301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: ID PA-1237) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CA PA15406) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2015-03-03 |