| NPI | 1265844708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-962) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA51635) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2021-05-24 |