| NPI | 1255531109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-338) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CA PA 19244) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2021-06-09 |