| NPI | 1093089872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 53575) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: VA 0110003801) |
| Enumeration Date | 2012-02-27 |
| Last Update Date | 2016-11-06 |