| NPI | 1134397870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA16068) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: CA PA16068) |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2011-03-21 |