| NPI | 1417254558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 56311) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9105832) |
| Enumeration Date | 2011-02-25 |
| Last Update Date | 2022-12-05 |