| NPI | 1215943758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA13597) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 13597) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2018-03-17 |