| NPI | 1184074452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-10216) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA53494) |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2022-08-31 |