| NPI | 1144333642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA21376) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL 00003315) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2020-05-14 |