| NPI | 1386272904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 11396) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 1386272904) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2023-07-20 |