| NPI | 1265732549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MO 2024011270) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 21247) |
| Enumeration Date | 2010-11-02 |
| Last Update Date | 2024-05-28 |