| NPI | 1407804206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA16931) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX PA08353) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2021-06-29 |