| NPI | 1336254705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA15385) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA PA15385) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2024-03-01 |