| NPI | 1104856574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA16717) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA PA16717) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2014-01-23 |