| NPI | 1326202227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA 52821) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 012584-1) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2017-03-30 |