| NPI | 1417389644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA51818) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA.60313098) |
| Enumeration Date | 2013-07-30 |
| Last Update Date | 2018-03-17 |