| NPI | 1174708275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA18775) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: TX PA05567) |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2016-12-15 |