| NPI | 1144685504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 54702) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NV PA1692) |
| Enumeration Date | 2015-12-29 |
| Last Update Date | 2018-03-17 |