| NPI | 1295049914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: AZ 5428) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA21074) |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2024-02-07 |