| NPI | 1124286893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CA PA53217) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 005100-1) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2023-09-19 |