| NPI | 1386841435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: AZ 5117) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA19174) |
| 363A00000X Physician Assistant (Licence: NV PA1087) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2021-06-09 |