| NPI | 1316456924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 54917) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OR PA210140) |
| Enumeration Date | 2017-09-26 |
| Last Update Date | 2022-12-07 |