| NPI | 1346226057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA20941) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 1060527) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2016-02-29 |