| NPI | 1285917328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 53160) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 53160) |
| 363AM0700X Physician Assistant, Medical (Licence: FL PA9113909) | |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2022-07-19 |