| NPI | 1144542457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA-1767) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA21543) |
| Enumeration Date | 2010-02-28 |
| Last Update Date | 2024-02-20 |