| NPI | 1326491440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA54683) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MD C06168) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2022-07-21 |