| NPI | 1356631675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 22252) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA054835) |
| Enumeration Date | 2011-04-08 |
| Last Update Date | 2024-06-12 |