| NPI | 1225302219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA22131) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 22131) |
| Enumeration Date | 2012-03-08 |
| Last Update Date | 2012-07-13 |