| NPI | 1316289192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA56688) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA173036) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2021-04-09 |