| NPI | 1104835404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA PA 13047) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2012-07-16 |