| NPI | 1386796738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD-60) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA12572) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2021-06-02 |