| NPI | 1417949330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TN 4459) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA11273) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2022-06-16 |