| NPI | 1316422876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TN 4203) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA56942) |
| Enumeration Date | 2018-10-01 |
| Last Update Date | 2021-06-21 |