| NPI | 1326361627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA20835) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA20835) |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2024-12-10 |