| NPI | 1174875793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA22917) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 6630) |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2015-03-31 |