| NPI | 1164581211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA16120) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA 16120) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2015-07-18 |