| NPI | 1215928171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 17474) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 51802) |
| 363AM0700X Physician Assistant, Medical (Licence: CA 17474) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2025-08-22 |