| NPI | 1306836507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA PA16784) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2023-04-12 |