| NPI | 1164725677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA22890) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA06832) |
| Enumeration Date | 2010-12-06 |
| Last Update Date | 2018-03-17 |