| NPI | 1326203936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 10432) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IA 000902) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2008-07-23 |