| NPI | 1326420217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 9453799-1206) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA57869) |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2021-09-23 |