| NPI | 1144625948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 55534) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NC 0010-05093) |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2021-06-02 |