| NPI | 1134257553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA13309) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2015-06-10 |