| NPI | 1285607259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA19539) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2010-03-05 |