| NPI | 1396844841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 18586) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60805208) |
| 363AM0700X Physician Assistant, Medical (Licence: CA PA18586) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2022-09-29 |