| NPI | 1184015182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA54387) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO PA0004463) |
| 363A00000X Physician Assistant (Licence: NV PA1587) | |
| Enumeration Date | 2015-02-11 |
| Last Update Date | 2019-12-23 |