| NPI | 1295955441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 10158) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA17110) |
| Enumeration Date | 2007-04-30 |
| Last Update Date | 2026-07-21 |