| NPI | 1376731257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: CA PA 14993) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 3793) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2016-05-24 |