| NPI | 1245471580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA20695) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9104705) |
| Enumeration Date | 2009-03-17 |
| Last Update Date | 2011-09-12 |