| NPI | 1124270277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA19914) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA151001) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2015-11-04 |