| NPI | 1366711558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA22163) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CT 002691) |
| Enumeration Date | 2011-12-19 |
| Last Update Date | 2023-02-22 |