| NPI | 1285802850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR 161825) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA20495) |
| 363AM0700X Physician Assistant, Medical (Licence: CT 002042) | |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2020-10-19 |