| NPI | 1437102613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: HI AMD 343) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA 19602) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2014-05-28 |