| NPI | 1134235773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA55863) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 152) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2019-07-12 |