| NPI | 1295024669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: 1690) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA21240) |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2021-08-25 |