| NPI | 1346351764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA pa13433) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 1028699) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2024-04-23 |