| NPI | 1194869883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA18663) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60316881) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2022-07-22 |