| NPI | 1144535220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CA PA21190) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9105536) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2022-04-29 |