| NPI | 1427413871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 55568) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9118628) |
| Enumeration Date | 2015-12-29 |
| Last Update Date | 2024-05-10 |