| NPI | 1316460249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA54984) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2017-07-23 |
| Last Update Date | 2019-04-05 |