| NPI | 1265669758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA21467) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 013288) |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2014-01-30 |