| NPI | 1245465806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 51536) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NH 0727) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2014-06-19 |