| NPI | 1083921472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA20685) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 20685) |
| Enumeration Date | 2010-09-07 |
| Last Update Date | 2025-02-25 |