| NPI | 1336198530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CA PA13684) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: HI AMD-214) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2008-02-28 |