| NPI | 1427575422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 54786) |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2017-08-29 |