| NPI | 1255433082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA18434) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 011123) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2024-10-17 |