| NPI | 1174033807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 58094) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 6942) |
| Enumeration Date | 2017-10-09 |
| Last Update Date | 2024-05-07 |